Stress Can Be A Royal Pain In The Gut

Stomachaches may be replacing headaches as Americans` most chronic physical complaint.

Some 4 million Americans seek medical treatment for ulcers each year and millions more are thought to suffer from various digestive disorders, such as colitis.

While there is much disagreement on the causes and cures of colitis, physicians are falling back on the old, often-debated theory that stress is a major cause of ulcers.

Limited use of over-the-counter antacid remedies and a close look at lifestyles can help many Americans avoid ulcers, says Dr. Gordon McHardy, an internationally recognized authority on digestive disorders.

McHardy, 75, is a professor of medicine at Louisiana State University and has spent almost half a century in the midst of the ongoing debate on ulcers. Even now he smiles warily when asked about the causes of a disorder that affects one in 10 Americans.

``The cause? We are still in a controversy about that,`` says McHardy, who stopped in Fort Lauderdale on a recent educational tour. ``In the past, stress was emphasized as the greatest item. And we`re beginning to go back to that idea. I think what causes ulcers is stress and the things that come with stress. People who are under stress may smoke and drink more and relax and sleep less.``

The rapid increase of female ulcer patients in the past decade also has led physicians to reconsider stress as a cause of ulcers. A few decades ago, only one in about 20 ulcer patients was a woman.

``There has been a tremendous increase of ulcers in females, which is probably due to stress factors and lifestyle change,`` says McHardy. ``Our studies now show a 1-to-1 ratio of ulcers between men and women.``

Physicians also have noted an increased incidence of ulcers in children and people older than 65. A majority of the latter, McHardy notes, are women.

``Sometimes we don`t think elderly people are under stress, but they are,`` says McHardy. ``They are quite often separated from a spouse or in a different environment. There is often frustration. Among older people, digestive complaints are usually passed off. And of course children are placed under competitive stress.``

Treatment of ulcers, however, still varies widely among physicians. McHardy is an advocate of a more natural, patient-controlled method of treating ulcers through lifestyle changes.

``I believe exercise is a real diversion from stress,`` says McHardy. ``Rest is the next most important item. And diet -- how you eat -- is the third item. If the physician is able to impart to the person some self-analysis to help the person see what disturbs them, then unquestionably they can avoid the disease and its recurrence.``

Most ulcer patients will attempt to make lifestyle changes -- such as reducing aspirin intake, alcohol consumption and cigarette smoking -- if the reasons for these changes are fully explained to them, says McHardy.

``Unfortunately the physician has been accused, and rightly so, of not treating the patient but treating the disease,`` he says. ``But almost all diseases have an emotional component.``

Effective ulcer drugs developed in the past decade have led some physicians to become less concerned with educating patients about what lifestyle changes may affect ulcer formation, says McHardy. Ulcers are holes in the lining of the stomach caused by oversecretion of the stomach`s digestive juices. Drugs, such as Tagamet and Zantac, work by suppressing the production of stomach acid. Tagamet, introduced in the United States in 1977, quickly became one of the most successful drugs in the history of the pharmaceutical industry.

Now, however, manufacturers of acid-suppressing drugs are warning physicians that overuse of the drugs may be harmful, says McHardy. The side effects may be dizziness, confusion and headaches. Recently, Tagamet has been associated with a higher risk of cancer, he says.

``The general family physician has gained too much confidence in a drug alone without educating the patient,`` he says. ``These drugs have been abused because the average family physician has told the patient to take them and take them indefinitely. Sometimes these acid-suppressing drugs will not be as effective in females or the elderly, who do not excrete as much acid.``

Besides patient education, McHardy often recommends new, milder ulcer drugs that work by aiding the body`s own defense mechanisms to suppress acid. He also prescribes over-the-counter antacids for relief of pain.

Despite the importance of lifestyle changes, McHardy does not emphasize a strict diet to prevent and treat ulcers.

``The management of the patient in the past was with a bland diet -- milk or cream on the hour,`` he says. ``But that has been discounted. Three small meals a day are usually fine.``